Drug Summary

Epinephrine Hydrochloride (1:10,000)

Pharmacologic properties:

Epinephrine is a sympathomimetic which stimulates both Alpha and Beta adrenergic receptors. Its effects are to increase systemic vascular resistance, arterial blood pressure, coronary and cerebral blood flow, heart rate and contractility. The alpha-adrenergic effect increases vascular resistance and coronary blood flow, which may make the fibrillating myocardium more susceptible to counter-shock. The beta adrenergic effect increases heart rate and cardiac output, and induces bronchodilation.

Indications:

  • Cardiac arrest (Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), Asystole, Pulseless electrical activity (PEA)
  • Symptomatic bradycardia
  • Anaphylactic shock
  • Newborn resuscitation/neonatal asystole or bradycardia
  • Pediatric bradycardia and cardiac arrest

Contraindications:

  • NONE in the cardiac arrest situation

Precautions:

  • Epinephrine is inactivated by alkaline solutions and should not be mixed with Sodium Bicarbonate
  • See Epinephrine 1:1,000 for non-cardiac arrest precautions

Adverse Reactions:

  • Cerebral hemorrhage
  • Tachycardia
  • Ventricular dysrhythmias
  • Hypertension
  • Angina
  • Nausea and vomiting

Dosage and administration:

  • Adult
    • Cardiac arrest:
      • 1 mg (10 mL) IV/IO, repeat every 3-5 minutes
    • Symptomatic bradycardia with hypotension, resistant to dopamine:
      • 2-10 mcg/min (Mix 1mg in 250 mL NS and begin at 30 drops/min)
    • Anaphylactic shock/allergic reaction (cardiac arrest or respiratory arrest imminent)
      • 0.5 mg IV
  • Pediatric
    • Cardiac arrest:
      • 0.01 mg/kg, (max 1.0 mg) IV/IO, repeat every 3-5 minutes
    • Bradycardia (heart rate < 60 bpm)
      • 0.01 mg/kg (max 1 mg) IV/IO, repeat every 3-5 minutes as needed
  • Newborn resuscitation
    • 0.01 mg/kg IV of a 1:10,000 solution, Repeat every 3-5 minutes